A Model-Based Economic Evaluation of Improved Primary Care Management of Patients with Type 2 Diabetes in Australia

Afzali, Hossein Haji Ali; Gray, Jodi; Beilby, Justin; Holton, Christine; Karnon, Jonathan

doi:10.1007/s40258-013-0062-9

Cited by 8 publications

(2 citation statements)

References 30 publications

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“…Nineteen studies were ex-post economic evaluations of which 17 were CEAs with one CUA [7, 12, 14, 15, 17] [18–30, 33]. All these evaluations compared a new intervention against current practice.…”

Section: Resultsmentioning

confidence: 99%

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Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review

2019

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Background Economic evaluation can inform whether strategies designed to improve the quality of health care delivery and the uptake of evidence-based practices represent a cost-effective use of limited resources. We report a systematic review and critical appraisal of the application of health economic methods in improvement/implementation research. Method A systematic literature search identified 1668 papers across the Agris, Embase, Global Health, HMIC, PsycINFO, Social Policy and Practice, MEDLINE and EconLit databases between 2004 and 2016. Abstracts were screened in Rayyan database, and key data extracted into Microsoft Excel. Evidence was critically appraised using the Quality of Health Economic Studies (QHES) framework. Results Thirty studies were included—all health economic studies that included implementation or improvement as a part of the evaluation. Studies were conducted mostly in Europe (62%) or North America (23%) and were largely hospital-based (70%). The field was split between improvement ( N = 16) and implementation ( N = 14) studies. The most common intervention evaluated (43%) was staffing reconfiguration, specifically changing from physician-led to nurse-led care delivery. Most studies ( N = 19) were ex-post economic evaluations carried out empirically—of those, 17 were cost effectiveness analyses. We found four cost utility analyses that used economic modelling rather than empirical methods. Two cost-consequence analyses were also found. Specific implementation costs considered included costs associated with staff training in new care delivery pathways, the impacts of new processes on patient and carer costs and the costs of developing new care processes/pathways. Over half (55%) of the included studies were rated ‘good’ on QHES. Study quality was boosted through inclusion of appropriate comparators and reporting of incremental analysis (where relevant); and diminished through use of post-hoc subgroup analysis, limited reporting of the handling of uncertainty and justification for choice of discount rates. Conclusions The quantity of published economic evaluations applied to the field of improvement and implementation research remains modest; however, quality is overall good. Implementation and improvement scientists should work closely with health economists to consider costs associated with improvement interventions and their associated implementation strategies. We offer a set of concrete recommendations to facilitate this endeavour.

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Section: Resultsmentioning

confidence: 99%

“…Thirteen of the studies (62%) attained a ‘good’ score of over 75. Only one study [33] obtained a ‘perfect’ score of 100 points. Improvement studies performed overall better than implementation studies on the QHES.…”

Section: Resultsmentioning

confidence: 99%

Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review

2019

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How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review

et al. 2016

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BackgroundThere are an increasing number of studies using simulation models to conduct cost-effectiveness analyses for type 2 diabetes mellitus.ObjectiveTo evaluate the relationship between improvements in glycosylated haemoglobin (HbA1c) and simulated health outcomes in type 2 diabetes cost-effectiveness studies.MethodsA systematic review was conducted on MEDLINE and EMBASE to collect cost-effectiveness studies using type 2 diabetes simulation models that reported modelled health outcomes of blood glucose-related interventions in terms of quality-adjusted life-years (QALYs) or life expectancy (LE). The data extracted included information used to characterise the study cohort, the intervention’s treatment effects on risk factors and model outcomes. Linear regressions were used to test the relationship between the difference in HbA1c (∆HbA1c) and incremental QALYs (∆QALYs) or LE (∆LE) of intervention and control groups. The ratio between the ∆QALYs and ∆LE was calculated and a scatterplot between the ratio and ∆HbA1c was used to explore the relationship between these two.ResultsSeventy-six studies were included in this research, contributing to 124 pair of comparators. The pooled regressions indicated that the marginal effect of a 1% HbA1c decrease in intervention resulted in an increase in life-time QALYs and LE of 0.371 (95% confidence interval 0.286–0.456) and 0.642 (95% CI 0.494–0.790), respectively. No evidence of heterogeneity between models was found. An inverse exponential relationship was found and fitted between the ratio (∆QALY/∆LE) and ∆HbA1c.ConclusionThere is a consistent relationship between ∆HbA1c and ∆QALYs or ∆LE in cost-effectiveness analyses using type 2 diabetes simulation models. This relationship can be used as a diagnostic tool for decision makers.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0466-0) contains supplementary material, which is available to authorized users.

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Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

et al. 2019

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A Model-Based Economic Evaluation of Improved Primary Care Management of Patients with Type 2 Diabetes in Australia

Cited by 8 publications

References 30 publications

Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review

Use of health economic evaluation in the implementation and improvement science fields—a systematic literature review

How Consistent is the Relationship between Improved Glucose Control and Modelled Health Outcomes for People with Type 2 Diabetes Mellitus? a Systematic Review

Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis

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